I work for a retinal specialist and we use a drug called Eylea, we use 2 units per eye and do a lot of bilateral injections. We code it out for 4 units and the Medicare HMOs are denying it stating frequency. They don't recognise that it is bilateral. Thr pay two units snd denipy the other two or pat all four, and take two units back. Can anyone Shea's some light on this, please, thank you.
I googled this: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Main%20Menu/Tools%20&%20Resources/Policies%20and%20Protocols/Medicare%20Advantage%20Reimbursement%20Policies/E/Eylea_08302012.pdf
It might give you some insight on how to bill that drug.